Healthcare Provider Details

I. General information

NPI: 1346199379
Provider Name (Legal Business Name): LYNDA OKEKE BENJAMIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3176 MAIN ST STE 1006
DULUTH GA
30096-3262
US

IV. Provider business mailing address

3176 MAIN ST STE 1006
DULUTH GA
30096-3262
US

V. Phone/Fax

Practice location:
  • Phone: 404-200-2524
  • Fax: 888-974-5887
Mailing address:
  • Phone: 404-200-2524
  • Fax: 888-974-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN292294
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN292294
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: